This Stroke Clinical Center Grant is a new application representing a continuation and extension of investigations initiated by the Comprehensive Stroke Center Contract, NINCDS, Contract No. N01-NS-8-2387, June 1978 - June 1981. The major trust of this contract is to assess the community (the State of Oregon in our case) profile of strokes, primarily demographic in nature; this contract mobilized a broad interest in our stroke patient, which represents the centerpiece of this grant application. Our investigations emphasize therapies focused upon stroke patients in three broad areas of importance in the continuum of the problem: (1) preventive therapy; (2) acute medical treatments; and (3) rehabilitation intervention for higher cortical impairment. (1) Preventive therapies are designed to assess various risk and prognostic factors in stroke patients to develop better molecular handles on both acute therapy and prevention. Factors which may yield to better identification and therapy of risks are: mononuclear cell cholesterol ester hydrolase activity; glycosylated hemoglobin; cholesterol turnover in artheromatous plaques; and physicochemical bases for platelet behavior in stroke. (2) Acute medical treatments focus initially upon the potentially beneficial assessment of prostacyclin infusion. In addition, staged, sequential evaluation of aminophylline/barbiturate and vasopressors will be continued in a prospective, randomized fashion. (3) Rehabilitative intervention for higher cortical impairment deals with neuropsychological and language impairments with compensatory learning strategies.